oid use (especially high dosage or prolonged use) (Caprioli, Campbell, Gaasterland, et al, 1996).
             Generally, patients are asymptomatic until optic nerve damage is quite advanced. Intraocular pressure may not reach extremely high levels, or it may rise very gradually, so patients may not experience discomfort or deterioration of vision for several years. Unfortunately, by the time vision is impaired, optic nerve damage is irreversible, except in unusual circumstances.
             Although it accounts for only a small percentage of all glaucomas, angle-closure glaucoma is considered a significant type of primary glaucoma. Unlike open-angle glaucoma, angle-closure glaucoma is relatively uncommon in African Americans and prevalent in people of Asian descent, especially the Inuit. Disease can be acute or chronic and is caused by anatomic narrowing of the anterior chamber angle, a factor that is fundamentally determined by genetics. This narrowing is primarily related to the size of the eyeball and the lens. In many cases, primary care physicians can detect a shallow anterior chamber and narrow angle with the flashlight test: A penlight is held at the temporal limbus of the eye, and the degree of illumination of the iris is noted; a narrow angle is suggested if the nasal half of the iris is in shadow (Vaughan D, Riordan, 1995). In an eye with a shallow anterior angle chamber, dilation of the pupil tends to further narrow the angle, leading to acute or chron!
             ic angle-closure glaucoma. Dim light or darkness, physical or emotional stress, and mydriatic agents can lead to pupillary dilation, thereby precipitating angle-closure glaucoma. Angle-closure glaucoma is most common in hyperopic (far-sighted) eyes and tends to run in families.
             In acute angle-closure glaucoma, intraocular pressure rises rapidly to very high levels. The eye becomes red and painful, and vision is severely blurred. An acute attack constitutes a medical emergency and must be q...